Teaching intermediary metabolism linearly doesn't work

Despite the fact that knowledge of the major biochemical metabolic pathways is essential to understanding the pathophysiology, clinical presentation, and management of many human diseases, there is disagreement among medical educators regarding the relevance of intermediary metabolism to the practicing physician and the expectations for medical students to master the various metabolic pathways. One basis for the widespread cynicism that exists regarding the need to teach medical students metabolic reactions and pathways derives from the fact that too often these aspects of biochemistry are taught as if they were isolated, unrelated, and independent bits of information. We use medium‐chain acyl‐CoA dehydrogenase deficiency as an example of how it is both possible and fruitful to teach two important but seemingly unrelated pathways in an integrated fashion and in the context of a specific clinical problem. This example illustrates how imbedding multiple metabolic pathways in a realistic clinical scenario and demonstrating the intimate interrelatedness of those pathways can provide the insight and understanding that are required for informed and rational diagnostic and therapeutic decision making. This article concludes with a series of practical and realistic recommendations for improving the teaching of intermediary metabolism.